Future of 2,000 employees, health delivery system at grassroots at stake

Looming closure of PPHI

PESHAWAR: The looming closure of the People’s Primary Healthcare Initiative (PPHI) has not only put the future of nearly 2,000 employees in the government-funded programme in the Pakistan Tehreek-e-Insaf (PTI)-ruled province in doldrums but also created uncertainty about the much improved health delivery system at the grassroots level.

The provincial Health Department in a recent notification asked the deputy commissioners of the districts where the programme is operational to take over the PPHI from June 30.

In the two-page notification, directives about funds, assets and audit have been given but not a single word has been mentioned about the future of the employees working in the programme for the last nearly 10 years.

The abrupt decision of the Health Department was like a bolt from the blue for the employees in a province where there are meagre job opportunities.

The PTI-led coalition government in its three-year rule in Khyber Pakhtunkhwa has failed to create enough job opportunities for the qualified youth. Even the thousands of vacant positions in the health, education and other sectors could not be filled during by thid government.

Uncertain about their future, the worried employees also staged protest outside the Khyber Pakhtunkhwa Assembly, but they failed to draw the attention of the uncaring members of the assembly and leadership of the ruling parties.

This correspondent made countless attempts on the cell phone of Health Minister Shahram Khan Tarakai and also sent SMSs to his number to get his version on the issue but to no avail.

With the implementation of the notification, more than 500 doctors, 1,000 paramedics and 250 managerial staff of the programme would lose their job.

“We have been serving here for the last 10 years. Now we are overage. There is great disappointment among our colleagues,” said an official of the programme.

After the introduction of the PPHI in 2006, the health delivery system at the basic health units showed marked improvement. According to data collected from the districts where the programme is operational, more than 4.5 million people were provided health services during 2015 only. 

PPHI was the brainchild of Pakistan Tehreek-e-Insaf (PTI) leader Jehangir Tareen. The programme was initially launched for the federal government and the BHUs were outsourced through Sarhad Rural Support Programme as implementing partner.

The Health Department was, however, not happy with the introduction of the new programme as it had challenged its monopoly, especially at the district level.

The operational cost of the programme and salaries of the employees were initially given by the federal government. The programme had a proper internal monitoring system. Besides, third party evaluation was regularly conducted to check the implementation and effectiveness of the PPHI and its reports helped in steering the future course of the programme.

After the 18th amendment and devolution of health to the provinces, PPHI was also devolved. Unlike other provinces, the programme suffered setbacks in Khyber Pakhtunkhwa where the provincial government was reluctant to continue the agreement.

Chief Minister Pervez Khattak, however, though an executive order gave extension to the programme till June 2018.

However, all of a sudden the SRSP reportedly withdrew its agreement and the Health Department without wasting any time circulated a notification on May 11, asking the district administrations to take over the basic health units from June 30.

A district support manager of the programme told The News that PPHI has proved efficient in making doctors and paramedic staff work and provide medicines to the patients at the BHUs. He claimed the PPHI restored the confidence of the people in the health facilities and strengthened the mother and child health services.

“The new initiatives of PPHI like introduction of free screening tests including ultrasound tests and availability of anti-rabies vaccines were other great achievements of the programme as the Health Department had been unable to arrange these services at the district headquarters hospital,” he pointed out.

Another official of the programme said the Health Department had no alternative arrangement for running the basic health units.

He said the Health Department was unable to run the institutions under its control in an effective manner owing to the lengthy government procedures and weak district offices.

The official said the Health Department didn’t have the capacity and the will to run the health delivery system at the local level and the BHUs would once again become dysfunctional.

He said the PPHI had Rs830 million in its accounts and this was enough to bear the operational costs of the project for more than three years and the government didn’t need to worry about the expenses.

He urged those at the helm of affairs in the provincial government and the high-ups of PTI to seriously look into the matter and take measures for further improvement of the health system at the grassroots level.